Non-surgical treatment of a coronarography-induced iatrogenic aortic dissection

Coronary dissection is an extremely rare but known complication of coronary catheterization and angioplasty. Due to its rarity, there are no management recommendations. However, surgery immediately after an endovascular procedure is frequently carried out under major antithrombotic treatment. The surgery and the postoperative consequences are therefore very complex. We report here the documented case of a type A aortic dissection after coronary catheterization. Despite extension to the entire ascending aorta which indicated surgical management, the benefit-risk balance argued for armed surveillance to avoid surgery under antiplatelets drugs without known antidote. We believe this case should lead us to systematically weigh the data before considering that any iatrogenic dissection of Dunning class 3 should be operated.

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Spontaneous Early Resolution of an Iatrogenic Type A Aortic Dissection Following Coronary Angiography

Aorta ◽

10.1055/s-0039-1683956 ◽

2018 ◽

Vol 06 (06) ◽

pp. 142-144

Author(s):

Yavuzer Koza ◽

Uğur Kaya ◽

Hakan Taş ◽

Enise Koza

Keyword(s):

Coronary Angiography ◽

Aortic Dissection ◽

Medical Therapy ◽

Ascending Aorta ◽

Artery Dissection ◽

Coronary Artery Dissection ◽

Type A Aortic Dissection ◽

Hemodynamic Compromise ◽

Iatrogenic Aortic Dissection ◽

St Elevation

AbstractA 74-year-old man was admitted with the diagnosis of non–ST-elevation myocardial infarction. During right coronary angiography, a coronary artery dissection extending into the proximal ascending aorta was noticed without hemodynamic compromise. Immediate computed tomography angiography showed no evidence of dissection in the ascending aorta. The patient remained hemodynamically stable with medical therapy alone. This case report highlights the importance of medical therapy in patients with uncomplicated iatrogenic aortic dissection.

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Surgical treatment of an aneurysm involving ascending aorta, aortic arch, and a rupture of a descending aortic aneurysm 26 years following acute type A aortic dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2005.08.055 ◽

2006 ◽

Vol 131 (1) ◽

pp. 235-236.e1 ◽

Cited By ~ 1

Author(s):

Christian Kühn ◽

Omke E. Teebken ◽

Jürgen Weidemann ◽

Matthias Karck ◽

Maximillian Pichlmaier ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Aneurysm ◽

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Ascending Aorta ◽

Acute Type ◽

Type A Aortic Dissection ◽

Descending Aortic Aneurysm

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Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

The Heart Surgery Forum ◽

10.1532/hsf98.20101170 ◽

2011 ◽

Vol 14 (6) ◽

pp. 373 ◽

Cited By ~ 4

Author(s):

Saina Attaran ◽

Maria Safar ◽

Hesham Zayed Saleh ◽

Mark Field ◽

Manoj Kuduvalli ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection ◽

Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

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Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Tilo Kölbel ◽

Christian Detter ◽

Sebastian W. Carpenter ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Open Surgery ◽

Type A ◽

Ascending Aorta ◽

Type I ◽

Acute Type ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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Extended and Total Aortic Resection in the Surgical Treatment of Acute Type A Aortic Dissection: Experience with 54 Patients

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)64656-5 ◽

1988 ◽

Vol 46 (4) ◽

pp. 420-424 ◽

Cited By ~ 65

Author(s):

Carlo G. Massimo ◽

Luigi F. Presenti ◽

Piezluigi Marranci ◽

Piero P. Favi ◽

Alberto G. Poma ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽

10.1055/s-0041-1722897 ◽

2021 ◽

Vol 09 (01) ◽

pp. 030-032

Author(s):

Sergey Y. Boldyrev ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Drug Induced ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

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